Strong Bipartisan Support for Controlled Psilocybin Use as Treatment or Enhancement in a Representative Sample of US Americans: Need for Caution in Public Policy Persists

Psilocybin is a naturally occurring psychedelic that has re-emerged in scientific and policy conversations because recent clinical research suggests potential therapeutic benefits, particularly when administered in controlled settings alongside psychological support. Earlier work indicates efficacy signals for conditions such as major depressive disorder and reports of positive psychosocial and pro‑social effects in healthy participants, while recognised acute and longer‑term harms appear to be highly context‑dependent and more likely during unsupervised or unregulated use. At the same time, regulatory change has begun: the FDA has granted psilocybin breakthrough therapy status for some depressive indications, and Oregon has decriminalised and legalised supervised psilocybin use in licensed facilities, including for non‑medical well‑being enhancement. Public attitudes toward these legal, supervised models remain understudied, and existing research on enhancement has focused mainly on cognitive ‘‘smart pills’’ rather than psychedelics or well‑being enhancement. Sandbrink and colleagues set out to fill this gap by measuring moral judgments about legally sanctioned, professionally supervised psilocybin use for either psychiatric treatment or for improving well‑being in healthy individuals (‘‘enhancement’’). The study presented nationally representative US adults with brief, scientifically accurate background information and randomly assigned them, in a between‑subjects vignette design, to evaluate the moral status of an individual’s supervised psilocybin use for one of those two purposes. The authors pre‑registered their analysis and aimed to test how moral evaluations vary by purpose and by individual difference factors such as political orientation, age, and moral foundations.

The investigators employed a between‑subjects experimental vignette design administered online. Participants first received concise, scientifically accurate information about psilocybin (its psychedelic properties, non‑addictive profile in controlled settings, and recent policy changes such as Oregon’s law) and were asked to imagine a future in which such laws existed at the federal level. They were then randomly assigned to one of two vignettes describing an individual taking psilocybin under the supervision of a trained professional, with the vignette differing only in the stated purpose: treatment of a psychiatric condition or well‑being enhancement for a healthy person. A nationally representative sample of US adults (recruited via Prolific) was targeted according to age, race and gender. The study initially recruited 805 participants; 10 were excluded for failing attention checks, leaving a final sample of N = 795. The sample’s median age was 44 (range 18–92); 49% identified as men, 48% as women, and 2% other/undeclared. Racial/ethnic composition was reported (74% White, 14% Black/African American, 7% Asian, 5% Hispanic/Latinx, smaller percentages for Native American, Pacific Islander, and other). The authors stated that with this sample they achieved a 5% margin of error per experimental condition at 95% confidence and 80% power to detect a small effect (Cohen’s d = 0.20). Primary outcome measurement was a moral evaluation of the individual’s supervised psilocybin use; comparisons to the scale midpoint were used to assess approval versus disapproval. At the end of the survey participants completed individual difference measures including moral foundations (care, fairness, purity), disgust sensitivity (Cronbach’s 𝛼 = .88), empathic concern (Cronbach’s 𝛼 = .89), and demographic items. Political orientation was measured with a two‑item average (Cronbach’s 𝛼 = .92). Disgust sensitivity and empathic concern were reported as unrelated to attitudes and therefore not discussed further. The study was pre‑registered and the anonymised data and analysis script were made available on the Open Science Framework.

The pre‑registered primary analysis found a small but statistically significant treatment–enhancement distinction: supervised psilocybin use was judged more morally favourable when described as treatment (n = 395, M = 29.5, SD = 21.7) than when described as well‑being enhancement (n = 400, M = 24.1, SD = 24.3). Welch’s t(786) = 3.34, p < .001, Cohen’s d = 0.24. Both conditions showed substantial moral approval relative to the scale midpoint: treatment yielded a large effect versus midpoint (Cohen’s d = 1.36, p < .001) and enhancement also produced a large effect (Cohen’s d = 0.99, p < .001). Expressed as probabilities of approval over the midpoint, 89% (95% CI [85.2, 92.1]) of participants reported moral approval of supervised psilocybin use for treatment, and 85% (95% CI [81.5, 88.5]) reported approval for enhancement. Political and age differences emerged in exploratory analyses: political liberals reported greater approval than conservatives (B = 4.89, t = 3.98, p < .001), and younger adults expressed greater support than older adults (B = -3.76, t = -2.63, p = .009). When participants’ moral foundations were entered into the model, care values showed a significant positive association with approval (B = 3.63, t = 2.80, p = .005), whereas fairness (B = 2.42, t = 1.64, p = .10) and purity (B = -2.11, t = -1.21, p = .23) were not significant predictors. In that model, age remained a significant predictor (B = -4.15, t = -2.92, p = .004), but political orientation dropped to non‑significance (B = 2.55, t = 1.86, p = .063), suggesting part of the political difference may be mediated by differing emphasis on care values. Reporting support by political group, 91% of liberals and 86% of conservatives favoured treatment uses; for enhancement, 89% of liberals and 78% of conservatives indicated approval. The authors noted that disgust sensitivity and empathic concern were not associated with attitudes toward psilocybin use.

Sandbrink and colleagues interpret their findings as evidence of strong bipartisan moral support among US adults for legally sanctioned, professionally supervised psilocybin use, both for psychiatric treatment and for well‑being enhancement, with a modest preference for treatment. They highlight that the moral foundation of care underlies favourable attitudes, and that age and political orientation account for some variation in support—older adults and more conservative respondents expressed somewhat less approval, although support for treatment remained high across political groups. The authors situate these results in relation to earlier work on pharmacological enhancement and psychedelics: approval in this study exceeded that commonly observed for cognitive ‘‘smart pills,’’ which the authors suggest may reflect differences between enhancement of well‑being (a non‑positional good) and positional goods tied to competitiveness. They also acknowledge contextual influences that could have shaped responses, notably high‑profile policy changes (for example, Oregon’s law) and increased media coverage of psilocybin around the time of data collection (summer 2021). Important limitations and cautions are emphasised. The study examined only legal, supervised use and did not address attitudes toward unsupervised, underground, or recreational use, settings that carry distinct risks; accordingly, its findings should not be generalised to those contexts. The authors warn against policy decisions driven by inflated expectations, noting both that psilocybin is not a panacea—citing a Phase II trial that found no significant difference on primary endpoints between psilocybin and escitalopram—and that concerns exist in the broader field about underreporting of adverse events, flexible analytic practices, inadequate controls, and conflicts of interest. They also flag uncertainty about population‑level public health impacts of wider access (for example, whether perceived acceptability might influence openness to other drugs or unsupervised use). In closing, the authors argue that, given the observed public support for supervised use, policy changes allowing controlled psilocybin in licensed settings may encounter little public backlash if similar information about risks and benefits is provided. Nevertheless, they call for rigorous research standards, transparent reporting, efforts to address knowledge deficits among both the public and some health professionals, and cautious policy deliberation to avoid premature or misleading claims about therapeutic potential.